Healthcare Provider Details

I. General information

NPI: 1013906049
Provider Name (Legal Business Name): WARREN N. MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 E FLAMINGO AVE
NAMPA ID
83687-9203
US

IV. Provider business mailing address

217 W GEORGIA AVE STE 115
NAMPA ID
83686-6811
US

V. Phone/Fax

Practice location:
  • Phone: 208-288-4970
  • Fax: 208-463-3044
Mailing address:
  • Phone: 208-463-3234
  • Fax: 208-463-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberM3815
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: